Education + Advocacy = Change

Click a topic below for an index of articles:

New Material

Home

Depression

Help us Win the Fight!

Alternative Treatments

Financial or Socio-Economic Issues

Health Insurance

Help us Win the Fight

Hepatitis

HIV/AIDS

Institutional Issues

International Reports

Legal Concerns

Math Models or Methods to Predict Trends

Medical Issues

Our Sponsors

Occupational Concerns

Our Board

Religion and infectious diseases

State Governments

Stigma or Discrimination Issues

If you would like to submit an article to this website, email us your paper to info@heart-intl.net

 ☼

~

any wordsall words
Results per page:

“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

  ☼

THE ABC D isaster


World AIDS Day 2005, along with the usual conferences, speeches and rallies around the globe, finally brought the voices to life that point at the failing and devastating effects of the ABC approach to HIV/AIDS prevention. The EU (in a statement [1]) and the UN (report of the Task Force on Women and Girls and HIV/AIDS in Southern Africa [2]), testimonies, articles, and interviews, all simultaneously seem to pay attention to at least the limitations and often the adverse effects of the ABC (Abstain, Be faithful, use a Condom) approach.

ABC education has, at least for the time being, the power of the purse and has by now a coca cola like coverage in Africa. It is also highly standardised - you see the same manuals, slightly adjusted to local circumstances, over and over again, spreading from South Africa north to the borders of the Arab world.

Since the introduction of ABC there has been scepticism, but almost of an apologetic sort. What could be heard was that abstinence is "of course" the ideal but since the reality is different, the messages should be targeting sexually active people. All couples being faithful is "of course" what we all would like to see, but since the reality is different, we need to talk a lot about condoms. Over the years, the A and B of the ABC tend to get a lot more emphasis than the C (clearly reflected in the materials and manuals where condoms feature on the last one or two pages of the teachers' guide). Something else also happened in the process: a whole generation of teachers, counsellors, and others involved in educating young people, who themselves enjoyed an at that time unprecedented sexual freedom in their adolescent years, are preaching abstinence without even confronting their own history, desires and practices within what they preach.

 

The criticism of the content of AB is simple: the messages cannot be implemented by substantial parts of the population, they are not geared at real life. Abstinence is not an option for many (poor) women and being faithful does not protect against HIV/AIDS infection. The "be faithful" message is especially disturbing. According to research, serial monogamy is what many young people in Africa see as desirable in terms of relationships. But being faithful only makes sense with regards to HIV/AIDS if you stay faithful to your first sexual partner for the rest of your life, being his/her first and only sexual partner as well, after having been tested and proven to both be negative. Few people in Africa or elsewhere will spontaneously mention that model as their ideal and even fewer will live accordingly. In a recent survey among 15-24 year olds in Malawi, 80% of the respondents say they are not at risk of contracting HIV/AIDS, some of them because they are not having sex at the!
 moment, but a substantial part say they are not at risk because they are faithful to their sexual partner. Being faithful is constantly mentioned in a context of HIV/AIDS prevention and even if the information given is correct, the ABC approach often connects being faithful to being protected against HIV/AIDS.

Many of the well intending ABC materials do pay attention to condoms, but somehow they manage to draw a picture of using condoms as a very exotic not to say alien habit, only fit for those who lack the self control and values to stay safe within A and B. And man, a lot can go wrong with condoms according to these manuals. Probably that is why they never reveal where you can get them. Or teach girls how to negotiate the use of condoms (they are endlessly lectured on how to say "no" instead).

Many educators and communicators in Africa and elsewhere, precisely because ABC has the power of the purse, agreed and implemented the ABC approach. But from a communication point of view there is a lot more wrong with ABC than the content of the messages alone. It is ineffective from a communication perspective. And ABC can lead to effects that would be comical if only the consequences were less tragic.

ABC yells one-liner slogans at people pretending to tackle very complicated, deeply personal and highly sensitive issues in a way that is almost offensive. If the ABC approach is anything, it is loud and omnipresent. I belong to none of the many target groups for HIV/AIDS prevention communication and I live in backwater Blantyre (Malawi), but I have been monitoring for a week and it turns out that on an average day (reading the newspapers, listening to the radio, going to work, walking in town, going to a bar, watching some TV), I receive at least ten HIV/AIDS messages. Or, to be more precise, I receive nine fear-inducing, sex-discouraging messages, and one condom promotion message (billboards from a South Africa based condom factory read: "Studded for more pleasure").

  ☼

By trying to take into account gender issues or the different positions of men and women with regards to HIV/AIDS, ABC education is revitalising double moral standards. Unlike South Africa, where virginity (and virginity tests) all of a sudden are portrayed as part and parcel of African authentic culture, virginity is not a common concept in Malawi. More than half of the girls in a recent survey had never heard of it. [3] The ABC approach will change that one too. In a sort of strange side effect of the abstinence mantra, manuals on sex education linger on virginity for pages. While virginity might seem a desirable state of being to some people, it is as useful in HIV/AIDS prevention as advising people to stay inside in order to reduce traffic accidents. Full blown double standards go unchallenged in the virginity discourse, since virgins are, we all know this, female.

The same double standards are resulting in hilarious communication hazards. One of the many NGOs here that were circulating messages on the occasion of World AIDS Day published two posters here. One portraying women in a village, pouring maize, the other portraying men drinking beer and playing trick track (ok, let's not split hairs here). The theme of World Aids Day being Keeping the Promise, the women on the poster say: "I promise to be mutually faithful", the men promise "to reduce the number of my sexual partners". Apart from the fact that it is hard to imagine how an individual can promise to be mutual, note that these promises, when kept, will lead to infection indeed.

Double standards, these days reinforced by ABC communication, heavily blind common sense. A 1997 Democratic Health Survey of Nicaragua states, without raising an eyebrow, that 55% of the boys between 15 and 19 are sexually active, while only 3% of girls in the same age group are. [4] Must be very busy, those 3%. Though there has not been a DHS survey in Malawi for some time, figures for Southern African countries are similar. Along the same lines, in the public discourse it is widely assumed and constantly communicated that men are having multiple sexual partners while women get infected by being faithful to unfaithful husbands. Might very well be, but with whom are these men having sex? Must be with unmarried women who are all abstaining from sex till marriage.

One might argue that all this lying about the reality of people's sexual life is rather innocent and of all times, but especially in the light of HIV/AIDS prevention it is a serious obstacle. We are in dire need of reliable information on what people do and don't, what they feel and think. Without that information we will not be able to develop prevention messages that can and will be implemented in real life. Instead of learning how to communicate meaningfully, honestly and openly about sexuality, ABC role-models, teaches and engrains shame, lying and useless values.

  ☼

The art of separating the discourse from the reality has risen to high heights, both because the ABC messages have little to do with real life and because ABC communication in itself is full of hidden and not so hidden moral messages on what sexuality should be (and not on what sexuality actually is). Recent research shows once again that Malawians are well informed on HIV/AIDS. Young people know about AIDS, they even can reproduce words like abstinence and being faithful and they do not change behaviour. 84% of 15-24 year olds are sexually active, 54% of men did not use a condom in their last sexual encounter, 73% of the women did not use a condom in their last sexual encounter. 70% of youths did not use a condom at sexual debut. Although using the words abstinence and being faithful, many of them indicate they are involved in occasional sex. [3] Clearly the messages received by these young people are being filed somewhere, they are being able to repeat them and to fit into!
 the discourse, it just does not occur to them to actually practice what they are saying. But maybe that should not surprise us, knowing that teachers deliver the ABC messages to them in a context where sexual abuse by the very same teachers is widespread.

 

Not all of the distorted discourse on sexuality can be assigned to the effects of ABC of course, but ABC does nothing to clear the air, to encourage open and frank discussion on the issues. Instead, it imposes rules on people that many people have no intention or possibility to obey.

AIDS is in Africa to stay, even if the epidemic stems tomorrow, AIDS will be a fact of life for generations to come. Since this became obvious, stigma and discrimination of people living with HIV/AIDS is getting placed higher on the agenda. Fighting the virus within an ABC context almost inevitably means condemning sexuality or at least a lot of sexuality (everything before, after or outside marriage, to be precise). By suggesting that faithful people cannot contract HIV/AIDS, the conclusion that a person infected must be a person with bad sexual practices and morals is almost logical. To say the least, ABC does nothing to fight stigma and discrimination. If you look at communication coming from organisations trying to improve the quality of life of people living with HIV/AIDS which are using ABC in their prevention efforts (the case with the vast majority of the many faith-based organisations active in this field), you can see how difficult it is to reconcile the messages. !
It goes like this: to get HIV/AIDS you have to be a very bad person but once you have it you deserve all the care and support you need. In addition, efforts to "justify" the safeguarding of human rights of people living with HIV/AIDS produce a constant stream of testimonies of two top models of "innocent" HIV/AIDS survivors featuring on the one hand the raped girl and on the other, the faithful wife.

In an advertisement for a contest, young Malawians were asked to write songs with the chorus starting: "A real woman waits..." (you could also write a song on "A real man waits..." but that did not seem to inspire anyone, no entrees received). Somehow I am sure the winning song will not read "A real woman waits 'till the condom is in place".

Joke van Kampen
Blantyre, December 2005
joke@malawi.net